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Peer 1

Generalized Anxiety Disorder 7 Scale

1. Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important

      The psychiatric interview is an important way to evaluate mental health and figure out what kind of psychiatric condition someone has. The mental discussion is made up of several important parts, such as:

      Presenting problem: The main reason the patient wants to see a psychiatrist is because of this problem. This part is important because it lets the doctor know what the patient’s main problem is, how bad it is, and what the best treatment plan should be.

      The past history of this illness: The past of current illness is what the patient says about their symptoms, including when they started, how long they lasted, and how bad they were. This part is important because it gives important information about how the illness will progress and helps the doctor figure out what might be putting the patient at risk.

  Psychological history: The patient’s family past, social support, work history, and drug use are all part of the psychological history. This part is important because it helps the doctor understand the patient’s situation and figure out what stresses or other factors might be causing or worsening the patient’s condition.

      According to  First, Gibbon, Spitzer and Williams, cited by the National Library of Medicine,  a fully organized mental interview that is done by a psychiatrist, psychologist, or even a student, nurse, or other person who has been trained for this reason. In this type of organized interview, the patient is asked set questions in a set order, and the answers are rated as positive, negative, or threshold. The fully organized conversation is based on some ideas that we want to find out more about. (First, Gibbon, Spitzer & Williams, 2002)

     A communicating, phenomenology-based, semi-structured interview with a therapist who is skilled and taught in dependability. The “structured” part of a “semi-structured interview” is a list of questions (usually a collection of related scales) that the interviewer must ask enough questions about to be able to score at the end of the interview. Here, on the other hand, the interview flows like a discussion. Questions are tailored to the situation and follow the patient’s story, but there is always a chance to ask for more information or examples. This includes the chance to gently stop and change the direction of the conversation. The patient is strongly urged to be spontaneous, remember, and think about things. “Yes/no” answers are never enough; the patient must always give examples in his or her own words

2. Explain the psychometric properties of the rating scale you were assigned:

     Since GAD is a type of anxiety disorder that is often found with other anxiety disorders (Kessler et al., 2012), it makes sense to use GAD-7 with other anxiety disorders. Also, the main sign of GAD is worry, which is a symptom of many mental illnesses and is therefore “transdiagnostic” (Harvey et al., 2004). Psychometric reviews of the GAD-7 show that it is a reliable and valid measure of GAD symptoms in both mental (Kertz et al., 2013; Rutter and Brown, 2017) and general community (Lowe et al., 2008; Hinz et al., 2017) groups. Spitzer et al. (2006) found that the GAD-7 has good psychometric qualities, such as sensitivity and specificity for identifying GAD. Sensitivity and specificity both go up and down in a constant way. A lower cut-off point means a higher sensitivity, but a lower precision. So, when setting a cut-off point, these two things should be taken into account. In the study by Spitzer et al. (2006), screening conversations were done with 965 people to see if they had GAD. Spitzer et al. (2006) found that a cut-off point of 10 was the best mix between sensitivity and specificity for the GAD diagnosis. Most people without GAD (82%) had GAD-7 scores of less than 10, while most people with GAD (89%) had scores of 10 or more.

3. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment.

      The GAD-7 is a seven-point measure with numbers from 0 to 3 for each question. It looks at how often seven different anxiety signs have bothered the patient in the last two weeks. Responses like “not at all,” “several days,” “more than half the days,” and “almost every day” get 0, 2, and 3 points, respectively. Scores of 5, 10, and 15 are used as cutoffs for low, moderate, and serious worry, respectively. If we use a cutoff of 10, the GAD-7 has a good sensitivity of 89% and a specificity of 82% for GAD. So, it is a powerful and effective way to screen for GAD. It also does a fair job of finding three other common anxiety disorders: panic disorder (74% sensitivity, 81% specificity), social anxiety disorder (72% sensitivity, 80% specificity), and post-traumatic stress disorder (66% sensitivity, 81% specificity).

With an incidence rate of about 8% Generalized Anxiety condition (GAD) is the most common anxiety condition seen in general care. GAD is linked to age and gender by statistics  and it is often found together with sadness and somatization. People with GAD have trouble with their daily lives and at work. This leads to a large number of days when people can’t work, which raises economic costs. From the primary care doctor’s point of view, it’s important to diagnose GAD in an accurate and cost-effective way so that the right treatment, like counseling, can begin and so that the patient doesn’t have to use more health services because of physical symptoms. Since there were no short, confirmed measures of anxiety, the GAD-7 was made as a quick self-report measure to find people with generalized anxiety in basic care. Even though they are the first, and sometimes only, point of contact with the health care system, general care doctors often miss signs of mental discomfort, especially worry . So, an easy-to-use and face-valid measure of GAD could help more people recognize the disorder and meet an important public health need.

The GAD-7 has been tested on a large group of patients in basic care and on a large group of people in Germany’s general population. Based on the results of applying the paradigm of classical test theory (CTT) and the related confirmatory factor analysis (CFA) methods, a one-factorial structure has been claimed and established, a high (and also subpopulation invariant) internal consistency ( = 0.89) has been reported, and reference scores based on norms for the general population have been given.

References:

Kessler, R. C., Avenevoli, S., McLaughlin, K. A., Green, J. G., Lakoma, M. D., Petukhova, M., Pine, D. S., Sampson, N. A., Zaslavsky, A. M., &

      Merikangas, K. R. (2012). Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent

      Supplement (NCS-A).  Psychological medicine,  42(9), 1997–2010. https://doi.org/10.1017/S0033291712000025

Kertz, S., Bigda-Peyton, J., & Bjorgvinsson, T. (2013). Validity of the Generalized Anxiety Disorder-7 scale in an acute psychiatric sample.

        Clinical psychology & psychotherapy,  20(5), 456–464.  https://doi.org/10.1002/cpp.1802Links to an external site.

Rutter, L. A., & Brown, T. A. (2017). Psychometric Properties of the Generalized Anxiety Disorder Scale-7 (GAD-7) in Outpatients with Anxiety

      and Mood Disorders.  Journal of psychopathology and behavioral assessment,  39(1), 140–146.  https://doi.org/10.1007/s10862-016-9571-9Links to an external site.

Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7.  Archives of

      internal medicine,  166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092

Peer 2

Mimi Myrlande

Initial Post

Three Components of Psychiatric Interview

The psychiatric interview involves several important components, including establishing rapport, assessing symptoms, and exploring psychosocial history. These elements play a crucial role in accurate diagnosis, treatment planning, and building a therapeutic alliance with the client (Skre, I., Hessen,  & Landrø, N. I. 2021).

· Building rapport is essential as it creates a trusting and empathetic environment, encouraging open communication and facilitating the sharing of experiences. Research by McCabe et al. (2019) emphasizes the positive impact of rapport-building on treatment engagement and outcomes.

· Assessing symptoms systematically helps identify the presence, severity, and duration of psychiatric symptoms, leading to accurate diagnosis and effective treatment planning. Wang et al. (2018) highlight the importance of comprehensive symptom assessment, including both positive and negative symptoms, in schizophrenia diagnosis.

· Exploring the client’s psychosocial history provides valuable insights into factors that influence mental health outcomes. Understanding past psychiatric history, social support networks, and adverse life events assists in tailoring interventions. Skre et al. (2021) emphasize the significance of assessing psychosocial factors to enhance treatment planning and outcomes.

BNSS and Psychiatric interview

The Brief Negative Symptom Scale (BNSS) is a validated rating scale specifically designed to assess negative symptoms in schizophrenia. It consists of 13 items measuring the severity of negative symptoms. Recent studies have examined the psychometric properties of the BNSS.

Savill et al. (2019) found that the BNSS demonstrates good psychometric properties, including high internal consistency (Cronbach’s alpha = 0.92) and interrater reliability (intraclass correlation coefficient = 0.87).

Using the BNSS during the psychiatric interview is appropriate when evaluating individuals suspected or diagnosed with schizophrenia or related disorders. The scale helps quantify the severity of negative symptoms, monitor changes over time, and guide treatment planning. Strauss et al. (2020) support the utility of the BNSS in assessing negative symptoms and monitoring treatment response in schizophrenia patients.

In conclusion, the psychiatric interview components of rapport-building, symptom assessment, and exploration of psychosocial history are essential for accurate diagnosis and treatment planning. The Brief Negative Symptom Scale is a reliable tool for assessing negative symptoms in schizophrenia, providing valuable information for treatment evaluation and intervention planning.

References:

McCabe, R., Kinnersley, P., & Freeman, M. (2019). The experience of healthcare professionals using information from patient-reported outcome measures to improve the quality of healthcare: A systematic review of qualitative research. BMJ Quality & Safety, 28(6), 436-448.

Savill, M., Banks, C., Khanom, H., Priebe, S., Wykes, T., & Corrigall, R. (2019). The Brief Negative Symptom Scale: Psychometric properties. Schizophrenia Research, 211, 258-264.

Strauss, G. P., Bowie, C. R., Kirkpatrick, B., & Buchanan, R. W. (2020). The Brief Negative Symptom Scale: Psychometric properties of a self-rated scale of negative symptoms. Schizophrenia Bulletin, 46(6

Wang, S., Zhang, Q., Zhao, Q., Xie, J., Wu, H., & Huang, M. (2018). Assessment of negative symptoms in schizophrenia: A psychometric analysis. Frontiers in Psychiatry, 9, 161.

Skre, I., Hessen, E., Borgen, L., Bronken, B. A., Håland, Å. T., Kvig, E. I., & Landrø, N. I. (2021). Psychosocial assessment in mental health care: A scoping review. Nordic Journal of Psychiatry, 75(2), 95-106.

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